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[SITUATION] · [ACTIVE] · [HEALTH]

2 clusters · 12 sources · 9 days · First seen · Last updated

US Medicare physician fee schedule changes

Overview

The Centers for Medicare and Medicaid Services (CMS) initiated a process to adjust physician reimbursements for 2027. Initially, CMS proposed a rule suggesting a decrease in payments for most physicians compared to 2026, driven largely by the expiration of a one-year 2.5% increase provided by Congress. The proposal included a 1.68% decrease for clinicians not in an Advanced Alternative Payment Model (APM) and a 1.19% decrease for qualifying APM participants. Specialty impacts varied, with clinical social workers projected to see a 12% increase, while dermatology and otolaryngology faced a 9% decrease.

In the final rule, CMS implemented deeper cuts than originally proposed. Most clinicians will face a 2.31% conversion factor reduction. Specifically, the conversion factor for non-APM clinicians will drop to $32.63, while qualifying APM participants will see a 1.83% decrease to $32.95. The final rule also introduces new billing structures for same-day visits, specifically reducing reimbursement for lower-valued office visits performed alongside 0-day global procedures to 80% instead of 100%.

Regarding hospital outpatient services, CMS finalized a 2.3% net increase in payment rates for hospitals meeting quality-reporting requirements, though this is offset by a 0.9% productivity adjustment. CMS also implemented changes to the 340B Drug Pricing Program, reimbursing 340B-acquired drugs at the average sales price minus 28%, a move expected to reduce drug spending by approximately $5.5 billion. Additionally, a 2% annual reduction to the OPPS conversion factor for non-drug items will be implemented to recoup approximately $7.8 billion in previous overpayments.

Entities

Medicare · Centers for Medicare & Medicaid Services · Mehmet Oz · American Hospital Association · Harvard Medical School

Claims

What the coverage asserts, and how many sources carry each claim.

Timeline

  1. [HEALTH] 11 sources
    CMS issues final 2027 Medicare payment rules for physicians and hospitals

    CMS finalized 2027 Medicare rules, including a 2.31% physician fee cut, 2.3% outpatient rate increases, and significant changes to 340B drug program reimbursements.

  2. [HEALTH] 2 sources
    CMS proposes 2027 Medicare physician fee reductions

    CMS has proposed a 2027 Medicare physician fee schedule that includes payment decreases for most clinicians following the expiration of a congressional increase.

Sources

amcp.org · cgmahq.org · chiefhealthcareexecutive.com · doctorsmanagement.com · healthcaredive.com · hfma.org · mdrevolution.com · optometrytimes.com · osteopathic.org · physicianspractice.com · spokey.cz · timelines.issarice.com

This summary has been updated 1 time: see revision history